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LaNoir, Daniel Edward IC FD it NEW YORK STATE DEPARTMENT OF HEALTH I Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Daniel Edward Lalloir Male Date of Death Age If Veteran of U.S.Armed Forces, 01/29/2024 63 Years War or Dates ZPlace of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address 35 Everts Avenue, Queensbury Town, New York 12804 11.1 0 Manner of Death a Natural Cause Accident El Homicide Suicide ❑Undetermined ElPending ILI V Circumstances Investigation G Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 21 Burial Date Cemetery,Crematory or Facility Name 02/01/2024 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation ❑Removal Date Place Removed f- and/or and/or Held N Hold Address O O. Date Point of Cl) Transportation ZS by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 2 Address w 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/31/2024 Registrar of Vital Statistics Caroline NIaegarde Barber(ECectronica((ySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- W Date of Disposition ZJ1IZy Place of Disposition '1FyLF� terniA'O LL,_ 2 (address) w CC (section) (lot number) (grave number) gName of Sexton or Person in Charge o/Pre es r �"3 Z (piece print) �' w Signature f Title (17t., 1441-Ut DOH-1555(07/18)p 1 of 2 1 7t ''E Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#